Midterm-Tests of Fetal Well Being Flashcards
Biophysical profile procedure
Done by US
Information given by biophysical profile
- Fetal muscle tone
- Placental grade
- Fluid level volume
- Fetal Breathing
Indications for biophysical profile
- Screening at 34-36 wks for out of hospital birth
- Post dates making sure preg still safe or >42 wks
- Any complications
- Question of fetal well being after 31 wks
- Anytime you think something is wrong & mom unsure of baby’s status
- Anytime standard of care recommends US and you feel woman’s level of responsibility is unclear
Information given by biophysical profile
- Fetal muscle tone
- Placental grade
- Fluid level volume
- Fetal Breathing
Polyhydramnios
> 20 cm of fluid
Fetal Movement Counts Procedure
- Mom sits quietly at same time each day
- Count 10 fetal mvmnt episodes where the baby moves either one body part or makes a series of movements (hiccoughs dont count)
- Record length of time elapsed to get 10 counts, have pt log result
Ominous sign from fetal movement counts
Increasingly longer time to get 10 mvmnts
Longer than 30-60 minutes to get 10 movements is concerning, have pt call you
When to use fetal movement counts
If anything is wrong
Post dates b/c of placental health issues
Fetal Vibroacoustic Stimulation Test (VAS)
Sound applied to maternal abdomen using a device that produces sound & vibration, fetus then stimulated w/ a high pitched sound intended to startle baby and accelerate FHT
Non-Stress Test
Procedure
- Fetal monitor with doppler to record FHT, transducer to record uterine activity, and monitor for noting fetal movement.
- Have mother note any movements she feels. Run strip for 20 minutes and assess fetal heart rate in comparison to FM (incr heart rate = incr FM; flat line heart rate = baby with no reserves)
- Be sure mother is well hydrated and well fed 8 hours before testing
Non-stress test
what does it tell you?
ominous signs?
- Shows whether baby is reactive. Reactive – if acceleration to at least 2 fetal movements, increase 15 bpm
- Ominous sings are lack of beat to beat variability in heart rate and/or no increase or decrease of FHT with movement after 40 minutes
- In general, 85% of all NSTs are reactive with 15% non-reactive. Normal fetal reactivity usually predicts survival of the fetus for another week. Non-reactivity can be caused by fetal sleep, hypoxia, CNS disorders, immaturity, or drugs.
- Bradycardia defined by FHT of 90 or less or 40 bpm below baseline lasting for at least one minute. This level of bradycardia is associated with higher rates of fetal morbidity even if N amniotic fluid level. Do biophysical profile and look for any fetal abnormalities. May need to deliver quickly or induce labor depending on outcome of US. This would most likely contraindicate an OOH.
Non-stres test
when to use?
-Complicate pregnancy – PIH, decr FM, something feels “weird”, baby compromised
Post dates
Fetal Vibroacoustic Stimulation Test (VAS)
Procedure
- Monitor FHT for 5-10 minutes to establish baseline and to see if there are accelerations. If accelerations present, no VAS is needed. No accels, then stimulate.
- Sound is applied to the maternal abdomen using a device which produces both sound and vibration. The fetus is then stimulated with a high pitched sound intended to startle baby and accelerate the FHT.
- If no accels with VAS, repeat up to 3x with at least 1 minute between blasts.
- Should see accel of FHT of 15 bpm above baseline for 15 seconds or more (same as NST)*
Fetal Movement Counts
Procedure
Have the mom sit quietly at same time each day (usu after a meal is best because want baby to be active)
Count 10 fetal movement episodes
Movement episode means each time the baby moves either one body part, or makes a series of movements
An episode is over when you don’t feel anymore movement
Record the length of time elapsed to get 10 counts
Have patient keep a daily log of the result.
Fetal Movement Counts
Ominous sign
increasingly longer time to get 10 movements
longer than 30-60 minutes to get 10 is very concerning, have patient call you
